An elderly patient does not want to be discharged. What is the key assessment to determine whether discharge is appropriate?

An elderly patient does not want to be discharged. What is the key assessment to determine whether discharge is appropriate?

• A. Discussion with patient about why discharge is considered, including medical and social factors.
• B. Explanation of why discharge is appropriate.
• C. Determining capacity.
• D. Asking if there are other people he wants to involve in decision making.

Answer: (C)

Determining capacity to decide about discharge is the crucial assessment. In discharge planning, the first question is whether the patient can make an informed, voluntary decision about leaving the hospital. This capacity is decision-specific and time-specific, and it hinges on four abilities: understanding the medical situation and the proposed discharge, appreciating the consequences of each choice (staying versus going home), reasoning about options, and communicating a clear, consistent decision. If the patient demonstrates understanding, appreciation, reasoning, and a stable choice, their preference regarding discharge should guide the plan. If capacity is lacking, a legally authorized or appropriate substitute decision-maker must be identified to determine the safest and most appropriate course of action for care. Other steps, such as discussing the reasons for discharge or explaining why discharge is appropriate, are important but do not by themselves determine whether discharge is appropriate—the ability to make a valid decision is the key factor.

Determining capacity to decide about discharge is the crucial assessment. In discharge planning, the first question is whether the patient can make an informed, voluntary decision about leaving the hospital. This capacity is decision-specific and time-specific, and it hinges on four abilities: understanding the medical situation and the proposed discharge, appreciating the consequences of each choice (staying versus going home), reasoning about options, and communicating a clear, consistent decision.

If the patient demonstrates understanding, appreciation, reasoning, and a stable choice, their preference regarding discharge should guide the plan. If capacity is lacking, a legally authorized or appropriate substitute decision-maker must be identified to determine the safest and most appropriate course of action for care. Other steps, such as discussing the reasons for discharge or explaining why discharge is appropriate, are important but do not by themselves determine whether discharge is appropriate—the ability to make a valid decision is the key factor.